ECMO SPECIALIST TEST REVIEW
QUESTONS WITH CORRECT
ANSWERS
Reperfusion Catheter: - Answer- - 5 or 7 fr (7fr has small bore stopcock)
- Use micropuncture kit for insertion
- If placed and flow still not obtained, you are in the profunda
Tubing: - Answer- - Polyvinyl Chloride
- 3/8 in
- 1 ft =20 mL
- Soft line coating (No heparin, No albumin)
CDI Venous Sensor: - Answer- - BLUE screen
- Trends: HCT, Hgb, Venous O2 Sat
- Placement on Circuit (Post Patient, Pre Manifold)
CDI Arterial Sensor: - Answer- - PINK screen
- Trends: pH, pCO2, pO2, temp, HCO3, ABE, SaO2 (circuit sat), K+
- Placement on circuit: Post oxygenator > duckbill valve > CDI sensor > stopcocks
- Inaccurate after Methylene Blue
Calibrating the CDI - Answer- Store > Recall > Back to Main Screen > Make
Adjustment; Green check mark
Heater/Cooler: - Answer- - Sterile H20
- Cold water on top, hot water on bottom (very accurate at controlling patient body
temperature)
Recirculation Line: - Answer- Post oxygenator (+ pressure) > one way duckbill valve >
CDI arterial sensor > manifold > return to venous (- Pressure) side
CRRT Connections: - Answer- - Post pump/Pre oxygenator
- Requires LARGE bore stopcock
- 'Access' (RED) closest to pump; 'Return' (BLUE) closest to oxygenator
- May have to move return to negative side if blood flow rate is high (Subtract BFR from
total ECMO flows)
Total Circuit Priming Volume: - Answer- About 500 mL
, Pharmacokinetic Drug Properties: - Answer- - Hydrophilicity
- Protein Binding
- Molecular Weight
- Degree of Ionization at given pH
Pharmacokinetics and ECMO: - Answer- - Augmented CO
- Leaky capillaries
- End-organ Dysfunction
- Hemodilution
- Drug sequestration
Analgesic Agents: - Answer- Best: Hydromorphone/Morphine
Low lipophilicity and protein bindings (completely received at 24 hrs)
Agitation: - Answer- Best: Precedex (Low lipophilicity)
Ketamine used as adjunct for increased sedation or for weaning
BENZOS are the DEVIL (Increases dependency and delirium)
Gram Negative Agents - Answer- Beta-Lactams: hydrophilic, renally eliminated, low
protein binding (Merrem, Zosyn)
Aminoglycosides: nephrotoxic, needs higher levels to kill bacteria (8-10x MIC)
(Amikacin)
Gram Positive Agents - Answer- Vancomycin: Hydrophilic and moderately protein
bound, great choice for ECMO
Linezolid: Should not be used on ECMO patients! Unpredictable! Call pharmacist is you
see this!
Antifungals: - Answer- -Candida species are most common fungal infections in ECMO
patients!
-Micafungin should be started right away if fungal infection is suspected (150mg/day)
-Fluconazole works great in ECMO patients at killing organisms
Antivirals: - Answer- Oseltamivir: prevent flu virus replication (ECMO + CRRT will
decrease concentrations)
Heparin (UFH) - Answer- - HL 90 min
- Indirection thrombin inhibitor; by inhibiting antifactor Xa via Antithrombin III (Amplifies
ability to breakdown clots)
- Reversal: Protamine Sulfate
- 5,000 units at insertion (we need to watch for wires to be in place and remind surgeon
about giving heparin bolus)
- Gtt start at 500 units/hr
QUESTONS WITH CORRECT
ANSWERS
Reperfusion Catheter: - Answer- - 5 or 7 fr (7fr has small bore stopcock)
- Use micropuncture kit for insertion
- If placed and flow still not obtained, you are in the profunda
Tubing: - Answer- - Polyvinyl Chloride
- 3/8 in
- 1 ft =20 mL
- Soft line coating (No heparin, No albumin)
CDI Venous Sensor: - Answer- - BLUE screen
- Trends: HCT, Hgb, Venous O2 Sat
- Placement on Circuit (Post Patient, Pre Manifold)
CDI Arterial Sensor: - Answer- - PINK screen
- Trends: pH, pCO2, pO2, temp, HCO3, ABE, SaO2 (circuit sat), K+
- Placement on circuit: Post oxygenator > duckbill valve > CDI sensor > stopcocks
- Inaccurate after Methylene Blue
Calibrating the CDI - Answer- Store > Recall > Back to Main Screen > Make
Adjustment; Green check mark
Heater/Cooler: - Answer- - Sterile H20
- Cold water on top, hot water on bottom (very accurate at controlling patient body
temperature)
Recirculation Line: - Answer- Post oxygenator (+ pressure) > one way duckbill valve >
CDI arterial sensor > manifold > return to venous (- Pressure) side
CRRT Connections: - Answer- - Post pump/Pre oxygenator
- Requires LARGE bore stopcock
- 'Access' (RED) closest to pump; 'Return' (BLUE) closest to oxygenator
- May have to move return to negative side if blood flow rate is high (Subtract BFR from
total ECMO flows)
Total Circuit Priming Volume: - Answer- About 500 mL
, Pharmacokinetic Drug Properties: - Answer- - Hydrophilicity
- Protein Binding
- Molecular Weight
- Degree of Ionization at given pH
Pharmacokinetics and ECMO: - Answer- - Augmented CO
- Leaky capillaries
- End-organ Dysfunction
- Hemodilution
- Drug sequestration
Analgesic Agents: - Answer- Best: Hydromorphone/Morphine
Low lipophilicity and protein bindings (completely received at 24 hrs)
Agitation: - Answer- Best: Precedex (Low lipophilicity)
Ketamine used as adjunct for increased sedation or for weaning
BENZOS are the DEVIL (Increases dependency and delirium)
Gram Negative Agents - Answer- Beta-Lactams: hydrophilic, renally eliminated, low
protein binding (Merrem, Zosyn)
Aminoglycosides: nephrotoxic, needs higher levels to kill bacteria (8-10x MIC)
(Amikacin)
Gram Positive Agents - Answer- Vancomycin: Hydrophilic and moderately protein
bound, great choice for ECMO
Linezolid: Should not be used on ECMO patients! Unpredictable! Call pharmacist is you
see this!
Antifungals: - Answer- -Candida species are most common fungal infections in ECMO
patients!
-Micafungin should be started right away if fungal infection is suspected (150mg/day)
-Fluconazole works great in ECMO patients at killing organisms
Antivirals: - Answer- Oseltamivir: prevent flu virus replication (ECMO + CRRT will
decrease concentrations)
Heparin (UFH) - Answer- - HL 90 min
- Indirection thrombin inhibitor; by inhibiting antifactor Xa via Antithrombin III (Amplifies
ability to breakdown clots)
- Reversal: Protamine Sulfate
- 5,000 units at insertion (we need to watch for wires to be in place and remind surgeon
about giving heparin bolus)
- Gtt start at 500 units/hr
